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Editorial: Death with dignity is about personal liberty

Posted:
10/25/2016 08:30:30 PM MDT

Updated:
10/25/2016 10:29:47 PM MDT

Debbie Ziegler holds a photo of her daughter, Brittany Maynard, the California woman with brain cancer who moved to Oregon to legally end her life in 2014, during a news conference to announce the reintroduction of right to die legislation in 2015, in Sacramento,Calif. (Rich Pedroncelli / AP)

Whether you call it "death with dignity," "assisted suicide," or Colorado's proposed "End-of-Life Options Act," the subject of life's final dance is fraught with existential moral questions influenced in many places by religious doctrine and traditions. These questions have been addressed by theologians and philosophers, physicians and medical ethicists, at lengths and depths that render any newspaper editorial simplistic and superficial by comparison.

Nevertheless, this complex question about how to deal with death once it becomes imminent and inevitable is now a Colorado ballot question — Proposition 106 — requiring us to consider whether, under carefully controlled circumstances, people diagnosed with a terminal illness and given six months or less to live should have the legal right to obtain medication that allows them to depart this earthly plane on their own terms in their own time.

Opponents are afraid of many unhappy possibilities, chief among them a slippery slope toward a general diminution of reverence for life that could lead to certain people — old people, sick people, disabled people — being considered expendable and somehow lassoed or coerced into premature death.

We don't minimize these fears, ubiquitous as they are in dystopian literary visions of humankind's future. Even to raise questions about the vast amounts of money spent on modern medical technology near the end of life, as former Colorado Gov. Richard Lamm famously did, is to trigger dire warnings of "death panels."

Fortunately, as we consider the much more limited question of patients for whom heroic medical efforts are no longer indicated, we are not flying blind. We need not be governed by guesswork or fear. We have data.

The Colorado proposal is based on Oregon's Death With Dignity Act, passed in 1997, which required, as Colorado's proposed statute does, detailed reporting of its use. In 2014, for example, 155 Oregonians obtained aid-in-dying prescriptions. Of those, 105 used them to end their lives. In a state with a population of about 4 million people, that represents two-and-a-half one-thousandths of 1 percent.

In the first 18 years of its operation, a total of 1,327 such prescriptions were written and 859 were used. In other words, for about one third of the people who availed themselves of the option, just having the option was good enough.

Neither age nor disability may be used as a reason to obtain such a prescription. Disability Rights Oregon, which is charged with protecting the rights of the disabled, has never received a complaint of abuse or attempted abuse of the Oregon Death With Dignity Act.

There has been no sign of a slippery slope. Oregon's law has not been changed or expanded in 19 years. It contains a host of protections, as does the Colorado proposal, ensuring a terminally ill person making such a request is mentally capable, free of coercion and aware of all the available options. The diagnosis of terminal illness must be made by two physicians. If there are indications of depression or other psychological issues, a mental health referral is required.

Another fear is that potential cost savings in medical care could influence decision-making around physician-assisted suicide. Two researchers, one a supporter and one an opponent of physician-aid-in-dying, reported in the New England Journal of Medicine that the cost savings are insignificant. These are terminal patients. Health care is devoted to keeping them comfortable, not to advanced, life-saving measures.

"Although we do not agree with each other about the ethics or optimal social policy regarding physician-assisted suicide and euthanasia, we do agree that the claims of cost savings distort the debate," Ezekiel J. Emanuel and Margaret P. Battin wrote.

Much of the literature in support of a right to die has focused on relieving unbearable suffering. But it turns out that pain management is not among the main concerns of patients who make use of Oregon's law.

"As in previous years, the three most frequently mentioned end-of-life concerns were: loss of autonomy (91.4 percent), decreasing ability to participate in activities that made life enjoyable (86.7 percent) and loss of dignity (71.4 percent)," the Oregon Public Health Division reported.

These are the issues that tip the balance for us. In a country built on a foundation of individual liberty, why should an individual facing a medical death sentence be obligated to lose everything precious to him or her as life ebbs away? Why should a free person not have the right to say, "Enough"?

It is the opponents of this right who would impose their values on others. No one is required to engage in this process. For all those who believe it inappropriate, there's a simple solution: Don't do it. Well-intentioned as they are, we believe these people have no right in a free society to tell others they may not decide of their own free will how the end of their lives must play out.

The Boulder County Medical Society agrees. So do the Denver and Pueblo Medical Societies. Once an opponent, the Colorado Medical Society commissioned an independent survey of Colorado physicians that found 54 percent in favor of medical-aid-in-dying legislation, 35 percent opposed and the rest undecided or neutral. As a result, the organization changed its position last month to neutral.

Washington State, Montana, Vermont and, most recently, California have followed Oregon's lead with similar legislation. Slowly but surely, Americans are rejecting the notion that they must be passive victims to a process that often strips them of their dignity and autonomy.

This is an expansion of individual liberty, not a threat to it. We hope never to face such a choice, but if we do, we hope to have this option, even if we never use it. We endorse passage of Prop 106.

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